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TRANSCRIPT
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Ateneo Central
13 de Julio de 2011
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Datos Personales
Sexo: masculino
Edad: 80 años
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Factores de riesgo
•Hipertensión arterial
•Dislipemia
•Sobrepeso
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Antecedentes
• Angioplastia carotídea con implante de Stent (2006)
• Portador de Miastenia Gravis
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ANGIOPLASTIA CAROTIDEA 2006
Pre angioplastia Post angioplastia
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Medicación Habitual
• Atenolol• Losartan• Atorvastatina• AAS• Clopidogrel• Prednisona
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Enfermedad actual:Paciente que es derivado al servicio para su evaluación, por presentar cuadro de mareo, el cual se produce al incorporarse y cede en pocos minutos. Niega otra sintomatología acompañante. Consulta a su neurólogo de cabecera quien solicita Doppler arterial de vasos de cuello.
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Doppler de vasos de cuello:• Presenta ateromatosis severa de arteria carótida interna derecha con estenosis que compromete la luz en un 80-90%.
• Ateromatosis moderada de arteria carótida interna izquierda con estenosis que compromete la luz en un 50-60%.
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Que conducta tomaría ?
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ANGIOGRAFIA CAROTIDEA 2011
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Evolución
•Durante la internación se diagnostica FA de tiempo evolutivo incierto, sin descompensación hemodinámica.
•Se decide anticoagulación con HBPM y control de FC con bisoprolol.
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Revascularización ?
Por qué método ?
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ANGIOPLASTIA CAROTIDEA
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Vía Radial derecha
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Medicación al alta
•Bisoprolol•Rosuvastatina•Losartan•Clopidogrel•AAS•Acenocumarol
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Incidencia anual de Stroke según la severidad de la estenosis carotídea
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Multicenter randomized trials in CEA vs CAS
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Rates of use of EPD
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Operator experience and outcomes
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Summary of critical trial attributes
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